Custodian for elderly with memory impairment in Sweden - a study of 260 physicians' statements to the court.

BACKGROUND: In the modern world with new family structures, international migration and increased life expectancy, there is a growing need for legal ways of assisting elderly with impaired mental capacity to decide about their life and assets. There are few studies about the physician's role when a court appoints proxies for vulnerable elderly. Many doctors do not know how to assess mental capacity, and most lawyers and judges know little about medicine. METHODS: Applications for a custodian sent to the Stockholm Chief Guardian' Office in Sweden were used. Physician's statements to the court for elderly with memory impairment were selected and 260 statements were scrutinized with regard to formal quality, the narrative content and the physician who wrote it. RESULTS: The quality of the statements varied from one sentence to excellent. Most statements were written by senior family practitioners or geriatricians. Seventeen % of the statements were handwritten and had more formal shortcomings than machine/computer written statements.The majority of patients needed massive help with daily life and economy. Median age was 84 years of age. MMSE score was given in 20% of the cases and varied from 6-27.A diagnosis of dementia was established in 57%. At the time of application, at least 48% were in a hospital or nursing home and at least 27% were in their private home. Only 5% were living with a spouse or a child. In 53% of the cases, the doctor knew the patient, but in 40% of the cases, the identity of the patient was not confirmed. The physician found that 54% were unable to understand the idea of getting a custodian, but out of those very vulnerable elderly, 20% had signed consent and 57% were considered able to be heard in court. CONCLUSIONS: There is a large variation in the quality of physicians' statements to the court concerning the mental capacity of elderly patients with cognitive impairment. Many statements have serious short-comings, and the system is not safe. There is a strong need for guide-lines, and additional training for all professionals involved.

[Design of the chest belt wireless health monitoring terminal for the old based on MSP430].

A real time monitoring terminal for the empty nest elderly based on extracting fabric type sensor and acceleration sensor combined with Bluetooth wireless communication technology is proposed. When the system detects arrhythmia and falls of the elderly, and then start the wireless bluetooth communication, complete the information interaction with mobile phone gateway device, so as to implement the rescue.

Control of measles in a juvenile custodial setting in the wake of the recent US outbreak.

The recent US measles outbreak is the largest since 1992. It is just a matter of time before measles is introduced into a juvenile custodial setting. Are we prepared? Should we be prepared? This short article addresses steps institutional settings should take to prevent the spread of measles in a contained setting.

Socio-cultural profile of Bapedi traditional healers as indigenous knowledge custodians and conservation partners in the Blouberg area, Limpopo Province, South Africa.

BACKGROUND: Bapedi traditional healers of Blouberg are custodians of indigenous knowledge on medicinal plants of this region. They provide primary health care to a large number of people in the Blouberg area of South Africa. There is concern that this profession is dying out, which may be detrimental to the Blouberg community and to biodiversity conservation in the area. METHODS: Thirty two healers and 30 community members were interviewed between March 2011 and July 2013 around Blouberg Mountain in the Blouberg Municipality. A semi-structured questionnaire was used to elucidate socio-cultural and demographic variables and healing customs of practicing healers. Attitudes to sustainable management of medicinal plants were captured. A second semi-structured questionnaire was used to gather information on community members' views of traditional healers and their practices. RESULTS: Sixty seven percent of interviewed community members visited traditional healers. Female traditional healers dominated (80%) the profession. Sixty four percent of the healers have no formal education, with only 4% having secondary school education. Seventy nine percent of healers see between 15 and 20 patients per month. Clinics and a hospital in the vicinity have resulted in a shift by the community from using tradition-based healing to that of allopathic health care. Most interviewed traditional healers (71%) are in favour of conservation actions to prevent over-harvesting, as 86% believe that indiscriminate collecting is compromising the flora of the area. Most (93%) are willing to use cultivated plants. CONCLUSIONS: State health care has negatively influenced the practice of traditional healing as patients now first consult government health centres before turning to traditional healers. In the past, traditional healing has been ignored because, as an oral history, it could not be included in school curricula or government policy documents. Those traditional healers who learn to write will have the skills to document and safeguard their own knowledge. This can help to prevent the erosion of knowledge around Blouberg's medicinal plants and support the conservation of natural resources in the area. Adult learning programmes might therefore be worth implementing amongst healers.

Unearthing the conflicts between carer and custodian: implications of participation in Section 16 hearings under the Mental Health (Compulsory Assessment and Treatment) Act (1992).

Mental health nursing occurs within a legal and ethical framework that presents conflicts between a paternalistic custodial role and an ethical commitment to autonomy. This paper considers the ethical conflict for nurses posed by acting as second health professional at judicial reviews under Section 16 of the Mental Health (Compulsory Treatment and Assessment) Act. Issues of advocacy and paternalism are discussed in light of the conflict between therapeutic and legislated roles. Strategies aimed at protecting the therapeutic relationship are outlined as a response to the current lack of guidelines in this area. Participation in legal processes of committal requires that nurses reflect carefully and critically on the ethical issues raised.

From chaos to calm: one jail system's struggle with suicide prevention.

This article profiles the suicide prevention practices at a large metropolitan jail, a facility that experienced nine inmate suicides in a recent 24-month period. The suicide rate in this facility was found to far exceed the rate for jails of comparable size as well as the national rate of jail suicides. The nine suicides are summarized and common features (including the issue of protective custody) of the deaths and systemic jail deficiencies are discussed. The process by which the jail system developed a suicide prevention program based upon the principles of staff training, identification/screening, communication, levels of supervision, housing, and intervention is offered.